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Models of counselling and psychotherapy indicated for diagnoses of depression include brief, goal-oriented interventions such as Cognitive Behavioural Therapy (CBT) or Interpersonal Psychotherapy (IPT), and are favoured by state funded mental health services. Whilst effective in addressing low mood these modalities provide little scope to consider the effect of structural and social inequalities that contribute to the known determinants of poor mental health, which have been exacerbated as a result of Covid-19. Using a fictional case study, this article seeks to explore the impact of oppressive, gendered, societal discourse on Simone's mental wellbeing during the Covid-19 outbreak. Using Narrative Therapy Principles, this article considers how Simone might use this therapeutic framework to reframe and re-author her experience, asking the question 'what's happened to me?' instead of 'what's wrong with me?' With the psychosocial legacy of Covid-19 predicted to be far reaching, opportunities exist for providers of counselling and psychotherapy to review the availability of therapeutic modalities that acknowledge the role and impact of social inequality and oppression on the lives of our clients. [ABSTRACT FROM AUTHOR]

Objective: The Ways of Responding (WOR) instrument measures compensatory skills, a central construct in some theories of the mechanism of cognitive therapy for depression. However, the instrument is time-consuming and expensive to use in community settings, because it requires trained independent judges to rate subjects' open-ended written responses to depressogenic scenarios. The present study evaluated the reliability and validity of a self-report version of the WOR (WOR-SR) in a community mental health sample with depressive symptoms (N= 467). Method: Subjects completed the WOR-SR, a modified version of the original WOR, and other measures of depressive symptoms, dysfunctional cognitions, functioning, quality of life, and interpersonal problems at multiple time points. Results: An exploratory factor analysis confirmed the two-factor structure of the WOR-SR. The positive and negative subscales both demonstrated excellent internal consistency (Cronbach's alphas = .91) and moderate convergent validity with other measures. Conclusion: The WOR-SR is a reliable and valid measure of compensatory skills in patients receiving treatment for depression at community mental health centers. [ABSTRACT FROM AUTHOR]

Background:While the general effectiveness of psychodynamic inpatient psychotherapy has been established, very few studies have specifically investigated the effectiveness of psychodynamic inpatient treatment of depression, though depressed patients represent the largest group of inpatients. Method :This study investigated two naturalistic samples of depressed patients regarding treatment outcome as well as clinical and treatment characteristics. Patients were treated in a psychoanalytical psychosomatic hospital unit. Data was collected from 2000 to 2002 (N=234) and from 2008 to 2010 (N=514). Data was acquired at admission and discharge. Results:The findings reveal high pre-post effect sizes for symptom reduction (SCL-90-R), general functioning (GAF) and medium changes of interpersonal problems (IIP). The improvement on the IIP was significantly higher for patients with comorbid personality disorder. Based on therapist ratings, the sample treated from 2008-2010 showed higher levels of impairment on several levels: chronic, complex, functional (GAF) and structural (OPD). Conclusion:Findings indicate that patients show substantial short-term benefit following psychoanalytic inpatient psychotherapy, as practiced under naturalistic conditions. Open questions remain regarding the long-term nature of these benefits and the possible influence of placebo-effects. [ABSTRACT FROM PUBLISHER]

Objective: Patients with eating disorders (ED) often suffer from co-morbid depression, which may complicate the ED treatment. Previous studies have found that ED interventions seem to have limited capacity to reduce depressive symptoms. Several studies of interpersonal psychotherapy (IPT), have found that when patients have been treated for depression, co-morbid symptoms have diminished. As depression and EDs are commonly co-occurring conditions, this pilot study aimed to examine the effect of an IPT treatment for these conditions, with the focus on the depressive symptoms. Method: In this multi-centre study, 16 patients with EDs and co-occurring major depression received 16 weeks of depression-focused IPT. Results: Significant improvements with substantial effect sizes were found for both depression (d = 1.48) and ED (d = .93). Symptom reduction in the two syndromes were strongly correlated (r = .625, p = .004). Patients with a restrictive ED did not improve on either depression or ED symptoms. Conclusion: These findings point to the usefulness of IPT for concurrent depression and ED with a bingeing/purging symptomatology. Working with negative affect and problem-solving related to current interpersonal problems may alleviate general psychological distress among these patients. [ABSTRACT FROM PUBLISHER]

Objective: Several randomized controlled trials have identified early response to psychotherapy as a predictor for later treatment outcome among patients with depressive disorders. However, supporting evidence under routine conditions is rare. This study evaluated the predictive value of early improvement for final outcomes in psychotherapy among depressive patients in the naturalistic setting of a German university outpatient clinic.Method:We used the method of percent symptom reduction to classify 639 patients with major depression or dysthymic disorder who underwent an average of 40.0 sessions (SD = 16.3) of naturalistic cognitive–behavioral therapy (CBT) as having either an early response or an early nonresponse.Results:Early response was a good predictor for final response and remission regarding depressive symptoms (OR = 8.75 andOR = 5.32, respectively), as well as overall psychological distress (OR = 3.95 andOR = 3.16, respectively). Early nonresponse was distinctly associated with later deterioration of both depressive (OR = 9.56) and general psychological symptomatology (OR = 4.92).Conclusions: Early response to psychotherapy has high predictive qualities for positive later treatment outcome in depressive patients under routine CBT. Therefore, early treatment effects should be considered in clinical decision-making and treatment planning in everyday clinical practice. [ABSTRACT FROM AUTHOR]

The assimilation model describes the change process in psychotherapy. In this study we analyzed the relation of assimilation with changes in symptom intensity, measured session by session, and changes in emotional valence, measured for each emotional episode, in the case of a 33-year-old woman treated for depression with cognitive-behavioral therapy. Results showed the theoretically expected negative relation between assimilation of the client's main concerns and symptom intensity, and the relation between assimilation levels and emotional valence corresponded closely to the assimilation model's theoretical feelings curve. The results show how emotions work as markers of the client's current assimilation level, which could help the therapist adjust the intervention, moment by moment, to the client's needs. [ABSTRACT FROM AUTHOR]

Objective:The aim of this study is to improve the understanding of self-changes after an intervention for depression focused on implicative dilemmas, a type of cognitive conflict related to identity. As recent research has highlighted the relevance of identity-related dilemmas in clients with depression, we sought to assess the way in which clients resolve such inner conflicts after a tailored dilemma-focused intervention and how this is reflected in the clients’ self-narratives.Method:We used three instruments to observe differences between good (n = 5) and poor (n = 5) outcome cases: (i) the Repertory Grid Technique to track the resolution of dilemmas, (ii) the Change Interview to compile clients’ accounts of changes at posttreatment, and (iii) the Innovative Moments Coding System to examine the emergence of clients’ novelties at the Change Interview.Results:Groups did not differ in terms of the number and relevance of client-identified significantly helpful events. However, between-group differences were found for the resolution of dilemmas and for the proportion of high-level innovative moment (IM) types. Furthermore, a greater self-narrative reconstruction was associated with higher levels of symptom improvement.Conclusions:Good outcome cases seem to be associated with the resolution of conflicts and high-level IMs. [ABSTRACT FROM AUTHOR]

Objective:This study tested emotion-focused therapy (EFT) theory assumptions concerning optimal emotion schematic processing during experiential psychotherapies. Emotion schematic change was investigated in the particular problem context of resolving self-criticism, an emotion schematic vulnerability to depression identified across all major psychotherapy theories.Method:The sample was nine highly self-critical depressed clients who received experiential treatment (n= 5 resolved whilen= 4 did not resolve their self-criticism by termination). Emotion episodes (EEs) were exhaustively sampled from five sessions across three therapy phases (early, working phase, and termination) for each client. All their EEs across therapy were coded using a process measure called the Classification of Affective-Meaning States. Three complementary analytic procedures were used to examine emotion schematic changes within and across phases of therapy: graphical/descriptive, linear mixed modelling, and THEME sequential pattern analysis.Results:Convergent evidence from these analyses supported EFT theory. Good resolvers of self-criticism decreased expression of secondary emotions and increased expression of primary adaptive emotions. Good resolvers also exhibited more sequences of EEs consistent with transformation of secondary and maladaptive emotions to adaptive emotions. Future directions of this research are discussed. [ABSTRACT FROM PUBLISHER]

Objective:Persistent low back pain (PLBP) is associated with vulnerability to depression. PLBP frequently requires major changes in occupation and lifestyle, which can lead to a sense of failing to attain one’s personal goals (self-discrepancy).Method:We conducted a clinical trial to examine the efficacy of self-system therapy (SST), a brief structured therapy for depression based on self-discrepancy theory. A total of 101 patients with PLBP and clinically significant depressive symptoms were randomized either to SST, pain education, or standard care.Results:Patients receiving SST showed significantly greater improvement in depressive symptoms. Reduction in self-discrepancy predicted reduction in depressive symptoms only within the SST condition.Conclusions:Findings support the utility of SST for individuals facing persistent pain and associated depression. [ABSTRACT FROM PUBLISHER]

Objective:Innovative moments (IMs) are moments in the therapeutic dialog that constitute exceptions toward the client's problems. These narrative markers of meaning transformation are associated with change in different models of therapy and diverse diagnoses. Our goal is to test if IMs precede symptoms change, or, on the contrary, are a mere consequence of symptomatic 15 change.Method:For this purpose, IMs and symptomatology (Outcome Questionnaire-10.2) were assessed at every session in a sample of 10 cases of narrative therapy for depression. Hierarchical linear modeling was conducted to explore whether (i) IMs in a given session predict patients' symptoms in the following session and/or (ii) symptoms in a given session predict IMs in the next session.Results:Results suggested that IMs are better predictors of symptoms than the reverse.Conclusions:These results are discussed considering the contribution of meanings and narrative processes' changes to symptomatic improvement. [ABSTRACT FROM PUBLISHER]

Objective:We previously examined alliance and therapist adherence as predictors of symptom change. Applying a new analytic strategy, we can ensure that any relations identified were not attributable to stable patient characteristics.Method:Participants were 57 depressed cognitive therapy patients. We disaggregated within- and between-patient variation in process measures.Results:Between-patients, variability in adherence to Cognitive Methods and Negotiating/Structuring predicted patients' symptom change. Within-patients, only variability in ratings of adherence to Cognitive Methods predicted next-session symptom change.Conclusions:Relations involving between-patient process variables are potentially attributable to stable patient characteristics. However, the relation of within-patient Cognitive Methods and session-to-session symptom change cannot be attributed to stable characteristics and is consistent with a causal relationship. [ABSTRACT FROM PUBLISHER]

Objective: This study explores the experiential process of psychotherapists during a session with a currently depressive client. Method: Individual and focus group interviews were conducted with 30 therapists and the grounded theory method was used as a methodological framework. Results: The therapists' experience was conceptualized as Experiential oscillation between getting closer to a client's depressive experience and moving away from it. Its development over the course of a session is depicted by a six-phase Depression Co-experiencing Trajectory model. Conclusions: The resultant theory interconnects different therapists' emotional responses to a depressive client within a coherent process model, which allows us to track the changes in therapists' experiences, to name the relations between them, and to connect them with the therapy's in-session microprocesses. [ABSTRACT FROM AUTHOR]

Objective: This investigation examined the relationship between in-session types of emotional experience operationalized by the emotion category coding system and the reduction of depressive symptoms in emotion-focused therapy (EFT). Method: Segments of videotaped sessions were coded and the different emotion categories were related to reduction in depressive symptoms in a sample of 30 clients who received EFT for depression. Results: Both fewer secondary and more primary adaptive emotions, in the working phases of therapy, were found to significantly predict outcome. Moderate levels of primary maladaptive emotion in the middle working session were associated with outcome and the frequency with which clients moved from primary maladaptive to primary adaptive emotions in this session-predicted outcome. Conclusions: Results of this study support a transformational model of changing emotion with emotion. [ABSTRACT FROM AUTHOR]

Objective:To explore hopes and expectations for therapy among a clinical population of depressed adolescents.Method:As part of a randomized clinical trial, 77 adolescents aged 11–17, with moderate to severe depression, were interviewed using a semi-structured interview schedule. The interviews were analysed qualitatively using framework analysis.Results:The findings are reported around five themes: “the difficulty of imagining what will happen in therapy,” “the ‘talking cure,’” “the therapist as doctor,” “therapy as a relationship,” and “regaining the old self or developing new capacities.”Conclusions:Differing expectations are likely to have implications for the way young people engage with treatment, and failure to identify these expectations may lead to a risk of treatment breakdown. [ABSTRACT FROM AUTHOR]

For mentalization theorists, implicit mentalization is a key component of all forms of therapy. However, it has been difficult to grasp and to describe precisely how implicit mentalization works. It is said to take place partly by mirroring others in posture, facial expression and vocal tone. Based on studies of imitative behaviour within linguistics and psychology, we argue that interactional mirroring is an important aspect of displaying implicit mentalization. We aimed to explore if, and in that case how, mirroring is displayed by general practitioners (GPs) and psychiatrists in consultations with patients with depression. We wanted to see how implicit mentalizing unfolds in physician–patient interactions. Consultations were video-recorded and analysed within the framework of conversation analysis. GPs and psychiatrists differed substantially in their propensity to mirror body movements and verbal and acoustic features of speech. GPs mirrored their patients more than psychiatrists in all modalities and were more flexible in their interactional behaviour. Psychiatrists seemed more static, regardless of the emotionality displayed by patients. Implicitly mirroring and attuning to patients could signify enactment of implicit mentalization, according to how it is described by mentalization theorists. We discuss reasons for the differences between GPs and psychiatrists, and their implications. [ABSTRACT FROM PUBLISHER]

The National Institute for Clinical Excellence in the UK published its guideline on the treatment of children and adolescents who have been diagnosed with depression in 2005. Although the guideline has not been updated since, it is widely used in Child and Adolescent Mental Health Services in England and Wales to advocate that all children and young people who have been diagnosed with depression should have access to individual cognitive-behavioural therapy (CBT) through the Children and Adolescent Improving Access to Psychological Therapies (CYP-IAPT) project. This article critically reviews the guideline in terms of the evidence that NICE cites for the efficacy of individual CBT. In particular, it provides a meta-review of four randomised control trials where the effectiveness of individual CBT was compared to another psychological therapy intervention, a non-specific control intervention and/or a wait-list. Each trial is considered separately, before looking at the overall evidence that they provide when the findings are considered as a whole. A trial comparing individual CBT to a non-psychological intervention (medication) is discussed separately. This review found that on present evidence, individual CBT cannot be viewed as evidence-based psychological therapy for children and young people who have been diagnosed with depression. [ABSTRACT FROM AUTHOR]

Objective: The concept of shared agency is used in examining the collaboration between the service user and the professionals. The study aims to find out what kind of experiences on shared agency mental health service users have. Method: The study was based on interviews of 19 service users. The data set was formed of those parts of the interviews that dealt with shared aims, being heard, collaboration and joint planning and decision-making. Typical methods of inductive content analysis were applied. Results: Three domains of shared agency were found: emotional, communicative and supportive ones. The emotional domain included elements of becoming heard and building confidence. In the communicative one, the main features were mutual information sharing, finding words to describe the chaos and reconstructing harmony. The supportive domain included encouragement and giving support. Experiences on non-shared agency were also found. Conclusion: Many experiences on shared agency were found. Joint planning and working with life goals were, however, seldom reported. This result, together with experiences of non-shared agency, sets a challenge for mental health services. [ABSTRACT FROM AUTHOR]

Mindfulness-based therapies are a recent development within the cognitive-behavioural tradition and an important element of the third wave cognitive behavioural therapy models. A number of these therapies could be considered to have mindfulness as a major component of the therapy. There has been a considerable growth of interest in these therapies with an accompanying increase in their evidence base. While a number of reviews have been conducted, these therapies were not comprehensively appraised. The most prominent of these therapies, mindfulness-based cognitive therapy, was developed to reduce relapse in recurrent depression. We conducted a meta-analysis which looked at therapies considered to have mindfulness as a major component. We investigated whether this group of therapies was effective in reducing current depressive symptom-atology as measured by the Beck depression inventory (BDI). A total of 11 studies were included in the analysis. We found a significant mean reduction score in current depressive symptomatology, as measured by the BDI, of 8.73 points (95% confidence interval = 6.61, 10.86). We found evidence for the effectiveness of these major-component therapies in reducing levels of active depression. The robustness of these findings is discussed alongside the implications for research and practice within the context of the current literature. [ABSTRACT FROM AUTHOR]

Poor adolescent adherence to mental health psychosocial treatment significantly undermines effectiveness. Approximately one-third of all youth drop out or prematurely terminate from psychosocial treatment. This study examined youth adherence to psychosocial treatment from the perspective of community-based mental health clinicians (n =34) interviewed across three focus groups. A grounded theory analysis was applied to investigate the promoters and barriers influencing adolescent adherence to treatment. Clinicians identified four domains (adolescent, family, clinician, and agency) that serve as promoters and barriers to adherence. Barriers to adherence were located primarily in adolescent and family domains, whereas promoters were attributed within the clinician domain. Understanding of the complex influences on adolescent adherence may facilitate increased awareness and intervention options for clinicians. [ABSTRACT FROM PUBLISHER]

This article reports the development and psychometric properties of two short forms of the 28-item Agnew Relationship Measure, the ARM-12 and ARM-5. For the ARM-12, results of previous research were used together with conceptual considerations to select three items to represent each of four ARM subscales: Bond, Partnership, Confidence, and Openness. For the ARM-5, item-analytic principles were used to select five items to represent overall alliance. In all three ARMs, client and therapist versions were constructed to contain parallel items. We drew data to assess reliability and validity from three UK trials of brief therapy for depression. Results indicated that the two short ARMs have acceptable psychometric properties and that they converged with each other and with the full ARM. [ABSTRACT FROM PUBLISHER]

Psychotherapy is widely held to be an effective means to decrease depression. It seems, however, that not everyone benefits from every kind of therapy, and the relevant outcomes vary from person to person. In this article, the pre-therapy views and post-therapy experiences of 14 users of either long-term psychodynamic psychotherapy or short-term solution-focused therapy are analyzed. The interviewees' personal views about their depression and therapy are approached with the concept of inner narrative. Three 'basic stories' or orientations were found: life historical, situational and moral. These offered people different contexts from which to evaluate the outcomes of their therapy. The findings suggest that a person's expectations, hopes and values are worth taking into account to ensure positive therapy outcomes. [ABSTRACT FROM AUTHOR]

This study investigated depressive symptom and interpersonal relatedness outcomes from eight sessions of manualized narrative therapy for 47 adults with major depressive disorder. Post-therapy, depressive symptom improvement (d=1.36) and proportions of clients achieving reliable improvement (74%), movement to the functional population (61%), and clinically significant improvement (53%) were comparable to benchmark research outcomes. Post-therapy interpersonal relatedness improvement (d=.62) was less substantial than for symptoms. Three-month follow-up found maintenance of symptom, but not interpersonal gains. Benchmarking and clinical significance analyses mitigated repeated measure design limitations, providing empirical evidence to support narrative therapy for adults with major depressive disorder. [ABSTRACT FROM AUTHOR]

Clinically depressed individuals have consistently been shown to demonstrate a bias for overgeneral autobiographical memory (ABM) disclosure, a strategy used to protect against the access of intense, primary emotions that may accompany specific memories. The present study examined how ABM specificity in client narratives was related to expressed emotional arousal in brief emotion-focused and client-centred psychotherapy for depression. Emotion episodes identified in two early-, two middle-, and two late-therapy transcripts drawn from 34 clients from the York I Depression Study were rated for degree of ABM specificity and expressed emotional arousal. A hierarchical linear modelling analysis demonstrated that greater ABM specificity was associated with higher expressed emotional arousal for clients who were no longer depressed at therapy termination. [ABSTRACT FROM AUTHOR]

The objectives were to examine the relationships among clients' affect regulation capacities, in-session emotional processing, outcome, and the working alliance in 66 clients who received either cognitive-behavioral therapy or process-experiential emotion-focused therapy for depression. Clients' initial level of affect regulation predicted their level of emotional processing during early and working phases of therapy. Clients' peak emotional processing in the working phase of therapy mediated the relationship between their initial level of affect regulation and their level of affect regulation at the end of therapy; and clients' level of affect regulation at the end of therapy mediated the relationship between their peak level of emotional processing in the working phase of therapy and outcome. Clients' affect regulation at the end of therapy predicted outcome independently of the working alliance. The findings suggest that clients' level of affect regulation early in therapy has a significant impact on the quality of their in-session processing and outcome in short-term therapy. Limitations of the study and future directions for research are discussed. [ABSTRACT FROM AUTHOR]

The psychometric properties of the Helping Alliance Questionnaire-I were analyzed at two times in short-term psychoanalytic supportive psychotherapy for outpatient depression. Exploratory factor analysis conducted in 142 patients generated a model that was confirmed in a different validation sample (n=106) using confirmatory factor analysis. Two factors were found to have satisfactory psychometric properties and a consistent structure over time: relationship and internal change. The authors conclude that reporting on the HAQ-I with separate scores for these individual aspects of alliance offers a more precise assessment and is preferable to using a single general alliance score. [ABSTRACT FROM AUTHOR]